Provider Demographics
NPI:1316757511
Name:RACKHAM, MATTIEKAY (MS, RDN)
Entity type:Individual
Prefix:
First Name:MATTIEKAY
Middle Name:
Last Name:RACKHAM
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 HILLSBORO PIKE STE 205
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2776
Mailing Address - Country:US
Mailing Address - Phone:615-200-0362
Mailing Address - Fax:615-616-0120
Practice Address - Street 1:4015 HILLSBORO PIKE STE 205
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2776
Practice Address - Country:US
Practice Address - Phone:615-200-0362
Practice Address - Fax:615-616-0120
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered